CMS looks to align measures across Medicare and Medicaid


The government wants to align priorities with the private sector and plans to wrap that objective into the development of accountable care organizations (ACOs), said Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS), in a keynote address June 7 at the Third National ACO Summit in Washington, D.C.

"It's about changing the way we deliver care," Tavenner said. "ACOs are part of that, but not the only way."

Tavenner noted that CMS is making a big effort to align all of its quality measures into a coherent system. "When we move forward, it won't be so much about the number of measures, but the quality of the measures and how they work across the system," she said, adding that, "there is a lot of work to do."

CMS is focusing on working with providers who care for dually enrolled beneficiaries in both the Medicaid and Medicare programs. "The current system is a bit fragmented," she said, and the goal is to have a more seamless system. CMS would like to align the quality measures for both, and currently has some pilots running across several states in that effort. "We've been accused of moving at lightening speed," she said. "I've never heard that about CMS before, so I'll take that one."

Tavenner said preventing fraud is at the top of the agency's priority list. "I continue to be amazed at the number of fraudsters after a large pot of government money," she said. CMS is trying to move away from "pay-and-chase" methods to predictive modeling to find fraud early on. She said the government is starting to see some results of that effort this year.

For its part, CMS is working to lower its administrative costs through simplification. "We are concerned about bending the cost curve," said Tavenner, adding that millions of baby boomers joining the Medicare program will make that all the more important.

"The last two-and-a-half years have been an incredible journey," Tavenner said. "It's interesting to see dialogue move from 'change is needed' to 'what type of change is needed?'"